A Randomized Clinical Trial of Multimodal Therapy and Mulligan’s Concept of Manual Therapy for Patients with Chronic Pain Syndrome Caused by Upper Cervical Spine Disorders

Abstract

Study Design: A randomized, parallel-group clinical trial, 2 weeks treatment period with follow-up reassessment after therapy. Objectives: To compare the relative efficacy of multimodal rehabilitation and Mulligan’s concept of manual therapy for patients with chronic neck pain and cervicogenic headache. Background: Cervicogenic headache and neck pain are the main syndromes caused by upper cervical musculosceletal disorders (C0-C3). According to clinical researches for about 20% of the patients with chronic unilateral headache, the cause is of the cervical origin. Relatively little is known about the efficacy of Mulligan’s concept of manual therapy for patients with chronic pain syndrome caused by upper cervical spine disorders. Methods: Patients (n=104) with chronic pain syndrome caused by upper cervical spine disorders, were randomized into two groups: multimodal therapy (massage, electrotherapy, ultrasound) and Mulligan’s concept of manual therapy group. Outcomes: pain intensity (VAS), neck disability index (NDI), range of motion (ROM). Results: Both groups (multimodal therapy and Mulligan’s concept) showed significantly reduced pain and disability, but the effect between groups wasn’t significantly superior with either therapy alone. Mulligan’s concept of manual therapy showed greater gains in range of motion; extension (p=0.01), left rotation (p=0.01) and right rotation (p=0.03) than the multimodal therapy. Conclusion: Mulligan’s techniques are an effective method in the management of upper cervical spine disorders.

The short and mid-term effects of Mulligan concept in patients with chronic mechanical neck pain

“…Therefore, in contrast of other studies [50], we conducted a series of sessions avoiding of single intervention protocol, to increase the possible therapeutic impact and reinforce generalizability of clinical indings. A number of nine session or more have been investigated in other studies with positive results [40,51]. Our study design based on the concept of Mulligan therapy effect incorporating all three main components of SNAG/self-SNAG and NAG identi ied the total clinical impact, against a control group.…”

“…In our study, control group incorporated in study design to limit confounding factors arising from natural history of pain. Put et al showed that Mulligan was superior in terms of ROM [51], comparing with a multimodal therapy consisting of cervical spine massage, electrotherapy and ultrasound in headache patients. Hussain et al, found superiority of NAGS opposite Maitland mobilization in neck patient's measurements of NPRS and NDI, after a fourweek period therapy with a frequency of four session per week [59].…”

Efeitos da mobilização articular do conceito Mulligan na cervicalgia crônica em adultos

“…Dentro do tratamento de cervicalgias, os NAGS são deslizamentos acessórios apofisários naturais aplicados à coluna cervical sem movimento ativo do paciente. Já os SNAGS são deslizamentos acessórios apofisários naturais sustentados pelos quais o paciente tenta mover ativamente uma articulação dolorida ou rígida em sua amplitude de movimento, enquanto o terapeuta realiza um deslizamento acessório paralelo ao plano de tratamento (PUT M, et al, 2016).…”

“…A técnica de self-SNAGS é importante para um auto gerenciamento terapêutico do próprio paciente com cervicalgia, pois o movimento ativo é executado com o deslizamento mantido nas facetas articulares, como recurso pode-se usar uma faixa self-SNAG, ou toalha, precisando de um profissional apenas para orientações e prescrição das séries (PUT M, et al, 2016;GAUTAM R, et al, 2014).…”